Preparing the United States for the Next Pandemic
Authors: Ashish K. Jha
Journal: Annals of Internal Medicine (2023)

EditorialsSeptember 2023Preparing the United States for the Next PandemicFREEAshish K. Jha, MD, MPHAshish K. Jha, MD, MPHBrown University School of Public Health, Providence, Rhode IslandAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M23-1894 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Although SARS-CoV-2 infections continue to occur, the United States has exited the emergency phase of the pandemic. COVID-19 is manageable without major disruptions to the health care system and society. Effective COVID-19 vaccines and treatments are accessible to nearly all Americans (1–3). The current moment of recovery is an important time to reflect on what went right and what went wrong in this historic pandemic to learn how to do better next time. In this issue, the American College of Physicians (ACP) presents thoughtful recommendations of how we might do so (4).When we first became aware of SARS-CoV-2 in early 2020, our nation was clearly not adequately prepared for what was to come. This lack of preparedness has been decades in the making: The challenges ranged from poor funding of public health and inadequate crisis coordinating mechanisms to inadequate attention paid to critical supply chains and an information ecosystem that would require a novel approach to communicating with the public (5, 6).The ACP recommendations begin to meaningfully address those gaps, including the need for investments in public health, data infrastructure, effective communication strategies, and personnel. The Biden administration has begun this investment with substantial funds flowing to public health agencies, including the Centers for Disease Control and Prevention and local public health departments, to begin to fortify personnel and modernize data. Translating these resources into effective action will be critical.The strengthening of supply chains is another area of substantial progress. When President Biden came into office, the key parts of the supply chain for vaccines, personal protective equipment, and other essential equipment were weak. Through both investments and sustained focus, those have been largely repaired. However, clear challenges remain in establishing a robust supply chain for all essential medical and health-related products that can withstand shocks like a global pandemic. The shortages of essential medicines that plague the United States and other nations of the world are evidence of these persisting challenges.Although it is essential to recognize how our nation was ill prepared, it is also essential to recognize that which went very right. The position paper does this—identifying vaccine development and telehealth as areas of success. I want to note 3 areas where we saw some success and need to redouble our efforts: building on real innovations of the pandemic, addressing the information crisis, and strengthening integration of health care and public health.Sustaining and Scaling Pandemic InnovationsAs the ACP notes, the pandemic brought groundbreaking innovations. While telehealth is widely touted, and rightly so, a closely related innovation that received less attention is the "test-to-treat" programs that improved access to care in a range of communities and addressed issues of equity (7). For example, in New York City, mobile vans traveled to communities to provide people who had COVID-19 symptoms with rapid testing and treatment on the spot (8). Delivery innovations need to be scaled up beyond the context of COVID-19 as a model of care delivery for acute diseases where a trip to the physician's office or emergency department is neither needed nor feasible.Another notable pandemic innovation was Operation Warp Speed. Partnership and collaboration between the federal government, private sector, and academia were the key ingredients of this program which delivered highly effective, safe vaccines in record time. We should model this program to develop other vaccines and treatments where progress is too slow. The Biden Administration recently launched Project Next Gen to accelerate development of the next generation of vaccines and treatments for COVID-19 with the hope of creating a sustainable model for the development of vaccines and treatments against future pandemics (9).The Role of Physicians in the Response to the Health Information CrisisUnfortunately, we practice medicine and public health in a polluted information environment. The pandemic has shown that an overabundance of bad information contributes to negative health outcomes (10). A top-down, central communications approach is ineffective in today's networked information ecosystem. The time for one trusted voice to speak to 330 million Americans is over. Physicians and other health care professionals are trusted sources of information for millions of Americans. They must know how to evaluate evidence and engage diverse people in well-informed conversations about health. It will be critical for organizations like ACP to take a leadership role in training physicians to more effectively share good information. This does not require physicians to go on television or social media; Those who prefer offline engagement can share good information at town halls, school board meetings, and elsewhere in the communities they serve.Strengthening the Integration of Public Health and Health CareEven the best-funded public health system cannot respond to a major health crisis on its own. The U.S. health care delivery system had to step up to meet needs during this pandemic that public health could not adequately address; however, moving forward, we need to invest in building the partnership between public health and health care. What might this look like? It starts with greater data integration—health care data and public health data rarely communicate with each other. Breaking down these silos will be critical, as will breaking down the cultural divides that separate the health care and public health communities. The ACP identifies health care workers as a reserve force for public health crises. Beginning to use that health care workforce to address the public health crises that exist today—such as the mental health crisis and the opioid crisis—can begin to build the partnerships that will be essential the next time a pandemic hits.As we come out of the emergency phase of the COVID-19 pandemic, it is essential that we use the lessons learned to be well prepared for the next pandemic or other public health crises. If we do not, we risk sliding back to where things were in 2019. The choice is both stark and consequential. The ACP position paper offers thoughtful steps we must take to build on innovations and address our gaps in healthcare delivery and equity. We have made real progress on pandemic preparedness over the past 2 years. Now is the time to not just continue that work but accelerate it—to ensure that when the next health crisis hits, we are ready.References1. Ioannou GN, Locke ER, O'Hare AM, et al. COVID-19 vaccination effectiveness against infection or death in a national U.S. health care system: a target trial emulation study. Ann Intern Med. 2022;175:352-361. [PMID: 34928700] doi:10.7326/M21-3256 LinkGoogle Scholar2. Zheng C, Shao W, Chen X, et al. Real-world effectiveness of COVID-19 vaccines: a literature review and meta-analysis. Int J Infect Dis. 2022;114:252-260. [PMID: 34800687] doi:10.1016/j.ijid.2021.11.009 CrossrefMedlineGoogle Scholar3. Bajema KL, Berry K, Streja E, et al. Effectiveness of COVID-19 treatment with nirmatrelvir-ritonavir or molnupiravir among U.S. veterans: target trial emulation studies with one-month and six-month outcomes. Ann Intern Med. 2023;176:807-816. [PMID: 37276589] doi:10.7326/M22-3565 LinkGoogle Scholar4. Serchen J, Cline K, Mathew S, Hilden D; Health and Public Policy Committee of the American College of Physicians. Preparing for future pandemics and public health emergencies: an American College of Physicians policy position paper. Ann Intern Med. 2023;176:1240-1244. doi:10.7326/M23-0768 LinkGoogle Scholar5. McKillop M, Lieberman DA. The impact of chronic underfunding on America's public health system: trends, risks, and recommendations, 2021. Trust for America's Health; May 2021. Google Scholar6. Mehrotra P, Malani P, Yadav P. Personal protective equipment shortages during COVID-19—supply chain-related causes and mitigation strategies. JAMA Health Forum. 2020;1:e200553. [PMID: 36218492] doi:10.1001/jamahealthforum.2020.0553 CrossrefMedlineGoogle Scholar7. Dasari S, Kurian S, Bastani R, et al. Streamlining test-to-treat: a novel care delivery model for COVID-19 oral antiviral access to close the equity divide in Los Angeles county. NEJM Catal Innov Care Deliv 2023;4(3). DOI: 10.1056/CAT.22.0328 Google Scholar8. Office of the Mayor, New York City. Mayor Adams launches nation's first mobile test to treat program, to provide immediate access to antiviral COVID-19 medications at mobile testing locations. 30 June 2022. Accessed at www.nyc.gov/office-of-the-mayor/news/465-22/mayor-adams-launches-nation-s-first-mobile-test-treat-program-provide-immediate-access-to#/0 on 17 July 2023. Google Scholar9. Diamond D. White House launching $5 billion program to speed coronavirus vaccines. Washington Post. 10 April 2023. Google Scholar10. Lee SK, Sun J, Jang S, et al. Misinformation of COVID-19 vaccines and vaccine hesitancy. Sci Rep. 2022;12:13681. [PMID: 35953500] doi:10.1038/s41598-022-17430-6 CrossrefMedlineGoogle Scholar Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAuthors: Ashish K. Jha, MD, MPHAffiliations: Brown University School of Public Health, Providence, Rhode IslandDisclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M23-1894.Corresponding Author: Ashish K. Jha, MD, MPH, Brown University School of Public Health, 121 South Main Street, Providence, RI 02903; e-mail, ashish_jha@brown.edu.This article was published at Annals.org on 25 July 2023. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics September 2023Volume 176, Issue 9Page: 1277-1278KeywordsCOVID-19Health carePrevention, policy, and public healthPublic policy ePublished: 25 July 2023 Issue Published: September 2023 Copyright & PermissionsCopyright © 2023 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...